AAFA Explains: Is Salt Therapy Safe and Effective for Asthma?

 

In our second post in our “AAFA Explains” series, we look at claims that salt treatment (also known as halotherapy) can improve your asthma.

This blog series looks at complementary and alternative medicine (CAM) aimed at asthma and allergies. The Asthma and Allergy Foundation of America wants to guide you as you decide between choices that may be “likely safe” or “potentially unsafe.”

CAM treatments usually do not go through the same rigorous scientific research as new drugs and medical procedures. As a result, whether or not CAM works (called efficacy) is unproven for most treatments.

Salt therapy – such as salt rooms, caves or lamps - falls into that category.

What is salt therapy?

“Salt rooms” are popping up in the U.S., Australia, the U.K. and elsewhere. These rooms charge you a fee to enter, like a spa. Salt crystals coat the rooms and the air is salt-laden as an attempt to mimic naturally occurring salt caves.

The history of natural salt caves as an asthma remedy is ancient. In Russia and Eastern Europe, people with asthma would descend into salt caves. The belief is that breathing in extremely small salt crystals would help open up the airways and assist with the buildup of mucus.

What does science tell us about salt therapy?

Studies evaluating salt therapy for asthma are few.

One of the largest studies to examine the use of salt caves evaluated the therapy for COPD (chronic obstructive pulmonary disease). COPD is a chronic disease of the lungs caused by smoking.

Researchers reviewed 151 articles about salt therapy. They checked for high-quality studies (randomized controlled trials), like those conducted for prescription medications.

Of the 151 studies, they found just one randomized controlled trial. Researchers reviewed three other studies to include more people. Many people in the studies reported feeling better after undergoing salt therapy. But researchers identified several quality concerns about these four studies.

As a result, researchers were unable to draw any conclusions. Some of the missing or incomplete information included:

  • Whether the subjects had COPD or asthma
  • What medications the patients took
  • How severe their breathing difficulties were at the start of the study
  • The long-term effect of the treatment (for example, people were examined only right after treatment)

In some countries, medical societies have warned that salt caves can have negative effects. For example, the salt cave could induce bronchoconstriction in some people.

Another danger is that if you have asthma, you may stop taking your regular medicine. Halotherapy is expensive. Many patients may struggle to afford both prescription medicines and salt therapy. But long-term control medications are needed to help prevent and control asthma symptoms. Take them as your healthcare provider tells you to, even if you feel well.

Is halotherapy safe?

"If your goal is to find a new way to de-stress, salt caves can do the trick. They’re cool, quiet and relaxing," said Maureen George, PhD, RN, AE-C, FAAN, a member of AAFA’s Medical Scientific Council, and an Associate Professor of Nursing at the Columbia University School of Nursing. "If you’re looking for a natural way to treat your asthma, halotherapy is not what you’re looking for. It has not been rigorously studied, despite claims from ‘experts’."

Patients should also know that inhaling concentrated salts (hypertonic saline) has been proven to irritate the airways, causing cough and mucus, which can make asthma worse for some people.

The bottom line:

Halotherapy, or sitting in a salt room, is not likely to make your asthma better. For most asthma patients, halotherapy is “likely safe.” Since you don't know how you will react, AAFA warns that it is best to err on the side of caution and avoid salt rooms.

Key definitions:

Randomized controlled trials: Participants are randomly placed into two groups. One group does not receive any treatment. The other group receives the treatment under consideration. Researchers follow both groups over time. At the end of the study, they compare results.

Efficacy: Whether or not a treatment works, and by how much.

Reference:

Rashleigh R., Smith S.M., Roberts N.J. (2014). A review of halotherapy for chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease.

Medical Review May 2016.

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First, I want to give full disclosure. I am commenting as a member of the salt therapy industry. Specifically, for even fuller disclosure, I'm chiming in on behalf of Halomed, a manufacturer of dry salt therapy equipment, which micronizes and disperses pharmaceutical grade salt in salt therapy room. In controlled halotherapy, the concentration of salt in the air is controlled by a sensor, which continuously measures the level of the salt in the air and signals the halogenerator to maintain the preset concentration. Halomed's parent company, Aeromed, pioneered salt therapy and has, since the early 1990s, been manufacturing and further developing the technology that makes salt therapy possible.

We dearly appreciate that the Asthma and Allergy Foundation of America has included an article on salt therapy. And we wish to emphasize that salt therapy should never replace the care of a professional healthcare provider, and that even though you may be receiving salt therapy, any changes in your treatment protocol should be done with your healthcare provider. That said, we are glad to report that studies continue on the role of salt therapy in providing relief for asthma and related respiratory conditions. Enough researchers in the field of respiratory health are intrigued by the results they are hearing of to advance the efforts to learn more so that clinicians can best serve their patients.  

If you are interested in trying salt therapy, please do some research before you visit a salt room. There are some salt rooms that are quite lovely, with salt paneled walls, loose salt on the floors and other effects. All of this is great and relaxing. But unless a salt room is equipped with a halogenerator, it cannot deliver salt therapy. There are claims salt on the walls and on the floor can deliver benefits, but we know of no evidence to support that. The air of natural salt caves does contain micronized salt, but that's because the air in these caves travels many miles before reaching the outer sections where people visit to receive salt therapy. The air picks up salt particles as it whooshes through the miles of walls of these enormous salt caves. If you want modern, above-ground salt therapy, in which you will be inhaling micronized salt, you want to visit a salt room equipped with a halogenerator, one that uses low to moderate salt concentration settings and is supported by effective ventilation.

Also, there is information to share with your healthcare provider about halotherapy from the American Lung Association. The ALA's senior scientific adviser, Dr. Norman Edelman, has commented that salt therapy can potentially confer more than just a placebo effect. On the ALA’s website (as of Aug. 24, 2018), Dr. Edelman states:

“Most people with obstructive lung disease such as asthma or COPD cough sputum (a thick mixture of saliva and mucus), and trying to bring it up can be distressing. (Think about the last time you had bronchitis, for instance.)

"When fine salt particles are inhaled, they will fall on the airway linings and draw water into the airway, thinning the mucous and making it easier to raise, thus making people feel better," said Dr. Edelman. "Also, these environments are allergen-free and thus good for people with allergies affecting their lungs."

You can see his comments at Promising or Placebo? Halo Salt Therapy: Resurgence of a Salt Cave Spa Treatment

Any good salt room operator will gladly explain how their halotherapy room works, and, as Halomed does, respect the importance of clinical care you are receiving. In fact, there are salt room owners who themselves are members of the healthcare community.  

A quick and important fact: Halotherapy's introduction to the United States occurred at a 1994 Virginia Commonwealth University-Virginia Biotechnology Research Park exhibition of Russian life-science technologies. Halotherapy was among numerous contenders who were evaluated for inclusion in this event after on-site visits were conducted in St. Petersburg and Moscow. 

 

This line is the article..."Patients should also know that inhaling concentrated salts (hypertonic saline) has been proven to irritate the airways, causing cough and mucus, which can make asthma worse for some people." 

Yes, because hypertonic saline is used to induce a reaction for testing.  That is a known. The water is what makes that happen.  However, that does not happen to that degree with dry salt therapy. It may make your throat tickle, and cause you to cough up more mucus, but that is what it's supposed to do. Like a natural decongestant and expectorant. NO DRUGS involved.

A sign of the times? ...

I don't know if anyone else has observed any kind of trend locally, but I recently learned that my pulmonologist had closed his practice.  I was visiting my regular doctor (whose office is on the same floor of the same building as my pulmo doc) and there was a letter taped to the glass door - the practice was closed with no forwarding address.

When I asked my regular doctor what happened, he said that with the modern medications available for asthma, COPD, etc., regular doctors can now handle most pulmonological health issues and testing.   (I will say that my regular doc does a great job in helping me manage my asthma).

Interestingly, a friend in another city (Nashville) reported the same thing - a pulmo doc he knew had also closed down his office. 

Unfortunately, there is no incentive for properly conducted trials of salt therapy ... or any other non-conventional therapy ... for asthma.  There is too much money at stake for big pharma!  Being a breathing disorder, if you can't breathe, then you are in big trouble and the drug companies know that!

When an Advair Diskus or similar sells for $400, something is very wrong!

With my health insurance, I have access to regular medications, but with all the potential side effects of those medications, I will still continue to look at inexpensive, unconventional treatment options.

It should be remembered that as many, if not more, deaths from asthma are the result of the medications - not the asthma!

 

Most Salt Rooms offer greatly reduced costs when purchasing multiple sessions, which chronic sufferers really need.  I don't believe in those cheap salt inhalers - there are no studies to support their effectiveness.  Some very minor, short-term relief might be possible, but most chronic sufferers won't be helped by them.  A certain saturation of tiny salt particles is necessary and it simply is not present with those cheap inhalers.  

Hugs, Msshale68! It sounds like you have definitely had a frustrating time. Have you checked out AAFA's blog post about What to Do If You Can't Afford Your Asthma Medications?

You may be eligible for other help as well - AAFA has a list of other patient assistance programs,.

Could you talk to your doctor about both the trouble you're having affording medications? You could also talk about whether it would be right for your particular health situation to do a trial of the salt therapy to see if it helps.

I would just like to say I have been diagnosed with asthma along with copd and early stage emphysema.... I have never smoked but have lived with smokers during my childhood... their smoking has condemned me to a certain outcome of death... i have gotten bronchitis every year for the past 35 years, walking pneumonia and whooping cough..... pollen aggravates my allergies and I have not slept more then 4 to 5 hours a night because of the coughing for the past 5 years..why do i have to pay the price for other peoples mistakes..... i did not ask to cough up a lung every day to the point my arms hurt and my head aches, to the point of vomiting.....I am willing to try anything to help alleviate the cough, to get the mucus out and fresh air in.... as a matter of fact, we have a dry salt theraphy room in our area and i plan to try it this next week...  their are also inhalers you can purchase to do the theraphy at home....  cost wise, my symbacort inhaler will cost me $280 a month and the Breo i was on that helped tremendously is $330 a month, neither of which i can afford now, where a dry salt room is $40 for the visit and the inhaler is $16..... the pharmaceutical companies could care less if i get the medicine i need and cant afford..they dont care if you live or die... only how much money they make.... no one invests time or money into seeing what works for people who cant afford the outrageous cost of medicines that could work and help... i recently found a dry salt theraphy room in my area and will be trying it out for myself.... unless you have these diseases and have walked in our shoes you dont know what you would be willing to for just one day of no coughing or wheezing, one full nights sleep.... 

Yes the chance of irritation is present, but that 'irritation' is a productive kind, as mucus is being discharged from the airways it blocks.  The Russian doctors are believers in medicine and say that sometimes medicine may initially need to be increased to calm the increased cough, as we experienced with our daughter.  But beyond that it did not occur and her meds were much less needed.

Interesting how this natural therapy is so scary to MDs, but the inhalers which have huge potential side-effects, including death, are prescribed without even informing the patient, who is usually not interested in reading the small print.  

Bottom line:  our health care industry is for-HUGE-profit, so repeat business is the primary goal.  Salt therapy does not fit that model..   

Maxmakc, that's great that salt room therapy has helped your daughter so much! And congrats to her being able to run cross-country now! I recently started biking and am learning how critical it is to have my asthma controlled.

One of the hesitations that many doctors have about salt therapy is that it has not been well studied in a scientific way. There are lots of anecdotal stories of how it helping people. But there is also the potential of it irritating the airways. Since there are no good studies, the potential for being helpful or harmful isn't fully known. The conclusion above is that it's "likely safe" but the overall benefit for treating asthma is an unknown.

Sadly, my daughter's allergist is not at all interested in learning about Salt Room Therapy.  We discovered it through a friend and researched it carefully.  It has trasformed a severly asthmatic child on lots of meds to a very mild case needing very little medication (who even runs cross-country now).  I understand a doctor's hesitation to learn something new, but to scare people away from it is just plain bad doctoring...

Salt Rooms are very beneficial and while MDs in the USA are not interested in them (they have enough on their plate) people who want true respiratory relief and less need of medication should be proactive and do their own homework.  With google it isn't hard. 

My allergies trigger my asthma.  I hope everyone gets better.  This is not fun.. The one place I want to be is outside. I am very limited to being out there.  I am Thankful for for every breath I get to take..

I've been going to pulmonologists, ENTs ,Allergists , holistic options , over and over again for 3o years. Asthma just got worse. Chronic cough. Even went to Cleveland Clinic Cough Clinic. Cough would never stop. Tried all drugs prescribed. Did test for gerd twice. DiD Everything and was compliant. Been going to salt suite near me for past 3 weeks- hour and half day and I HEAR the silence of not coughing ALL the time and lungs feel not as tight. No other changes so I'm sticking to it. Remarkable difference. I live in FL where weather stays the same so can't say related to that. It's the salt room. I'm a skeptic yet after all been through..Including Buteyko which believe is also helpful to follow principles..Yet whether proven or not..I see it is helping. Did years ago yet not as often and not double sessions. I went as was feeling desperate. Not cured by any means and on advair yet that's it. Can even tolerate inhaling advair better now without coughing it out due to reactive airways.

It definitely helps for me and maybe more people who Asthma should be required to live by the ocean. I mean maybe this is something that should really be considered by lawmakers because it is all so hurtful for me dealing with my condition.

Yeah I tried some Himalayan pink salt from the indian grocery store and it seems to be having a really good effect on me because I get a good feeling and feel very rejuvenated..........I guess it helps clear the dust out of my system and breathing better.

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